UNIVERSITY OF THE PHILIPPINES VISAYAS

Miagao, Iloilo

REQUEST FOR WAIVER OF MRR

____________________, 2010
Date

Vice-Chancellor for Academic Affairs

U.P. in the Visayas
Miagao, Iloilo

I, ___________________________, _______________, of the College/School of

Name of Student Degree/Year Level
________________would like to request for waiver of the Maximum Residence Rule and
extension of residence effective ___________ to ___________ for the following reasons:
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________

_______________________
Signature of Student

Study Plan for the Period of Extension

___________, AY_____ ___________, AY ______ _____________, AY ______

Course Units Course Units Course Units

______________ ______ _______________ _______ ________________ ______
______________ ______ _______________ _______ ________________ ______
______________ ______ _______________ _______ ________________ ______
______________ ______ _______________ _______ ________________ ______
______________ ______ _______________ _______ ________________ ______
______________ ______ _______________ _______ ________________ ______
______________ ______ _______________ _______ ________________ ______

Prepared by: __________________ Recommended by: __________________

Signature of Student Signature of Adviser
Date: __________________ Date: _________________

______________________________________________________________________________________
ACTION OF THE VICE-CHANCELLOR FOR ACADEMIC AFFAIRS

[ ] Approved [ ] Disapproved

Remarks:
________________________________________________________________
________________________________________________________________
________________________________________________________________

__________________________
Vice-Chancellor for Academic Affairs
Date: __________________
To be filled up by the Office of the College Secretary

Summary of Academic Performance

Sem/AY Units Units Academic Passing REMARKS
Enrolled Earned Status Percentage

TOTAL

Number of Semesters Enrolled: _____ LOA: ____ AWOL: _____ TOTAL: _____
Total units required by program: Units earned/credited: ______
Units remaining:_____ To be enrolled ______ Removed: ______ Completed ______
Passing rate per semester ________ units/sem GWA: _______

Prepared by: ________________________ Certified Correct: _______________________

Student Records Evaluator College Secretary
Date: __________________ Date: _______________
Remarks: Remarks:
_______________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
 RECOMMENDATION OF COLLEGE

Recommending Recommending

[ ] Approval [ ] Approval
[ ] Disapproval [ ] Disapproval

Remarks:
______________________________________
______________________________________
______________________________________
______________________________________
Remarks:
______________________________________
______________________________________
______________________________________
_______________________________________

_____________________________________ _________________________________
Div/Dept/Col. Admissions Com. Chair Dean
Date: ________________ Date: _________________

________________________________________________________________________________________
Comments/Recommendation of the University Registrar
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________
_________________________________________________________________________________________

___________________________________
University Registrar
Date: _________________

win/mydoc/forms/092010